| NPI | 1164629408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 5656) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: FL 5656) |
| 111NT0100X Chiropractor, Thermography (Licence: FL 5656) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2007-07-08 |